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Chronic Kidney disease Diet Therapy

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Chronic Kidney disease Diet Therapy. Undergraduate Case defense. Bachelor of Science in Nutrition

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Chronic Kidney disease Diet Therapy

  1. 1. CHRONIC KIDNEYCHRONIC KIDNEY DISEASE STAGE 5DISEASE STAGE 5 with;with; AnemiaAnemia HyperkalemiaHyperkalemia Metabolic acidosis &Metabolic acidosis & Uppper Gastro-IntestinalUppper Gastro-Intestinal BleedingBleeding Timothy M. Zagada HNF 42 S2-2L
  2. 2. General InformationGeneral Information Name of patient: JG Ward No. 3 Age: 46 Date of Admission: July 14, 2008 Hospital: Philippine General Hospital (PGH)
  3. 3. Socio-Economic HistorySocio-Economic History Married with 5 children High school graduate Permanent residence in Taguig Works as a security guard ◦ Wakes up early and prefer foods that are easy to prepare (ex; noodles, canned goods, fried) Smoker (quitted a year ago) Alcoholic for 28 years (17-45 yrs of age)
  4. 4. Medical HistoryMedical History Present Illness: CKD stage 5 secondary to Hypertensive Nephrosclerosis  Anemia  Hyperkalemia  Metabolic Acidosis  UGIB Chief Complaint: Generalized weakness
  5. 5. Medical HistoryMedical History Past Illness: known hypertensive for more than 20 years. ◦ One month prior to admission  Gradual onset of on and off epigastric, burning in character.  Nausea  Occasional vomiting of previously ingested food  Progressive body weakness and myalgia
  6. 6. Medical HistoryMedical History ◦ Two days Prior to Admission  Gradual onset of on and off epigastric, burning in character.  Vomiting (coffee-ground material)  Epistaxis  Increased sleeping time. ◦ Past surgeries: None ◦ Allergies: None ◦ Past Hospitalization: Yes
  7. 7. Medical HistoryMedical History Physical State of Health ◦ Loss of appetite PTA ◦ Gastric pain caused by UGIB (resolving) ◦ No elimination/ excretion problem Family Medical History ◦ The patient’s mother is hypertensive
  8. 8. Theoretical considerationTheoretical consideration Chronic Kidney disease is a progressive and irreversible damage of the functioning unit of kidneys, the nephrons. ◦ Function of Nephrons;  Filtration  Iso-osmotic reabsorption  Osmotic concentrator  Electrolyte reabsorption  Water reabsorption
  9. 9. EtiologyEtiology Immunological, metabolic, renal vascular. Primary tubular and congenital disorders. Vascular lesions that can lead to renal ischemia and kidney tissue. Chronic Glomerular disease, such as glomerulonephritis. Chronic infections, such as chronic pyelonephritis
  10. 10. EtiologyEtiology Metabolic disorder like Diabetes Mellitus Excessive pressure against the blood vessel walls or hypertension Genetic factors
  11. 11. Stages of CKDStages of CKD Stage Description GFR, mL/min per 1.73m2 Action 1 Kidney damage with normal or high GFR >90 Diagnosis and treatment, slowing progression, CVD risk reduction 2 Kidney damage with mild decrease in GFR 60-89 Estimating progression 3 Moderate decrease GFR 30-59 Evaluating and treating complications 4 Severe decrease in GFR 15-29 Preparation for kidney replacement therapy 5 Kidney failure <15 or dialysis Kidney replacement (if uremia present) The patients GFR is 2.9 thus, belongs to stage 5
  12. 12. IncidenceIncidence
  13. 13. IncidenceIncidence
  14. 14. What is Dialysis?What is Dialysis? is a way of maintaining the patients’ regular excretion of the body’s waste products. Works on the principles of the diffusion and osmosis of solutes and fluid across a semi-permeable membrane. Examples are Hemodialysis and Peritoneal Dialysis
  15. 15. HemodialysisHemodialysis The patient's blood is shunted from the body through a machine for diffusion and ultrafiltration and then returned to the patient's circulation
  16. 16. Assessment of NutritionalAssessment of Nutritional StatusStatus Anthropometry ◦ % Standard weight= (69 kg/ 63 kg) x 100 =109.5% ◦ BMI= 69/ 1.702 =23.88 ◦ % weight change= 1.5% less
  17. 17. Assessment of NutritionalAssessment of Nutritional StatusStatus Biochemical Assessment Laboratory Results Normal Values Actual Values Variance Rationale for Variance BUN 2.60-6.48 mmol/L 94.13 mmol/L 87.65 mmol/L or higher Failure in kidney functions Creatinine 53.00-115.00 umol/L 3202 umol/L 3087 umol/L or higher Failure in kidney functions RBC 4.3-5.9 x 106 /mm3 2.25 x 106 /mm3 3.65 x 106 /mm3 or less Anemia (reduced EPO roduction) Hemoglobin 13.6-17 g/L 6 g/L 11 g/L or lower Anemia (reduced EPO roduction) Hematocrit 39-49% 19% 30% or lower Anemia (reduced EPO roduction) GFR <greater than 130 mL/min per 1.73m2 2.9 mL/min per 1.73m2 127.1 L/min per 1.73m2 Renal Failure (CKD stage 5) Potassium 3.8- 5 mmol/L 6.9 mmol/L 1.9 mmol/L or higher Hyperkalemia
  18. 18. Assessment of NutritionalAssessment of Nutritional StatusStatus Clinical Assessment Body parts Clinical sign Possible Nutrient Deficiency Others Conjunctivae pale Vitamin A Low hemoglobin/RBC Nailbeds pale Zinc Low hemoglobin/RBC Tongue (posterior) Blackish discoloration Riboflavin/Niacin Presence of infection Mouth Uremic Breathe - Caused by uremia Vascular system High blood pressure - Caused by alcohol and smoking Muscular system Weakness - Low hemoglobin/RBC
  19. 19. Dietary AssessmentDietary Assessment DBW= (170-100) -10% = 70 - 7= 63 kg TER= 63 x 35 (method II)= 2205 kcal or 2200 kcal CPF distribution (60-15-25) CHO= 2200 x 0.6=1323/4= 330.75 g or 330 g PRO= 2200 x 0.15= 330/4= 82.5 or 85g FAT= 2200 x 0.25= 550/9= 61.1 or 60 g
  20. 20. Dietary AssessmentDietary Assessment Prior to Admission ◦ Kcal=2240, CHO=334g, PRO=74g, FAT= 67.5g • CHO % Adequacy= 334/330 x 100 = 101.21% • PRO % Adequacy= 74/85 x 100 = 87.1% • FAT % Adequacy= 67.5/60 x 100 =112.5% • Energy % Adequacy= 2240/2200 x 100 = 101.18
  21. 21. Dietary AssessmentDietary Assessment During Confinement ◦ Kcal=1900, CHO=334g, PRO=74g, FAT= 67.5g TER= 63 x 30= 1900 kcal PRO= 63 x 1.1= 70 g PRO kcal= 70 x 4= 280 kcal Non PRO kcal= 1900-280= 1620 kcal CHO: 1620 x 0.7= 1134 - 148 (dialysate)= 986/ 4=246.5 or 245 g FAT: 1620 x 0.3= 486/9= 55 g
  22. 22. Dietary AssessmentDietary Assessment CHO % adequacy= 164/245 x 100 =66.94% PRO % adequacy= 56/70 x 100 = 80% FAT % adequacy= 30/55 x 100 = 54.5% Calorie % adequacy= 946/1900 x 100 = 49.8% During Confinement % adequacy
  23. 23. Nutrient-Drug InteractionNutrient-Drug Interaction Name of Drug Indication Possible Interactions NaHCO3 Metabolic acidosis Neutralizing gastric acid Amlodipine Osteodystrophy Inhibit the transport of calcium into myocardial and vascular smooth muscles Clonidine Hypertension Inhibits cadioacceleration and vasoconstriction Kalimate Hyperkalemia Exchanges sodium ions for potassium Lactulose Q8 Uremia inhibits diffusion of ammonia from the colon , lowers pH Furosemide Uremia Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tube. Erythropoetin 4000 ‘u Anemia Stimulates erythropoesis Vitamin K tablets Hypokalemia Synthesis of blood coagulation factors
  24. 24. Nutritional Care PlanNutritional Care Plan Identification of Problem Parameters Medical Problems Nutritional Problem Anthropometry None None (Normal BMI) Biochemical Accumulation of BUN and Creatinine Anemia Hyperkalemia Uremic syndrome Dietary Metabolic acidosis Gastric pain Drug and Nutrient Interaction Furosemide causes hypokalemia Weakness Others Hypertensive UGIB Nausea, Vomiting
  25. 25. Nutrient Implications andNutrient Implications and ReccomendationsReccomendations Should have enough energy and protein to maintain the patients DBW. Two thirds of the protein must come from sources of High Biological Value (HBV) to assure the essential amino acid requirements. Regular monitoring of lab results is essential to evaluate the patient’s condition while in hemodialysis
  26. 26. Diet PrescriptionDiet Prescription TER= 63 x 30= 1900 kcal PRO= 63 x 1.1= 70 g PRO kcal= 70 x 4= 280 kcal Non PRO kcal= 1900-280= 1620 kcal CHO: 1620 x 0.7= 1134 - 148 (dialysate)= 986/ 4=246.5 or 245 g FAT: 1620 x 0.3= 486/9= 55 g
  27. 27. Diet PrescriptionDiet Prescription Diet Rx: 1900 Calorie CHO245 PRO70 FAT55 148 kcal from dialysate 1200 mg P 3000 mg Na 2000 mg K 1800 mg Ca 1500 ml Fluid
  28. 28. Meal Plan Food group Ex Pro Na K Ca P Fluid CHO Fat Kcal Milk A powd 1 8 160 400 360 250 0.6 12 10 170 Meat Grp A 3 24 90 600 45 210 93 - 1 105 Lean Meat Fish B.1 1/2 4 15 100 17.5 45 17.5 - 0.5 20.5 Egg 1 8 110 95 50 115 45 - 6 86 Total 44 375 1195 472.5 620 156.1 12 17.5 381.5 Food grp Ex Pro Na K Ca P Fluid CHO Fat Kcal Veg grp A 2 1.2 4 120 30 30 60 3 - 16.8 Rice - A - B 6 24 920 240 80 140 40 138 - 648 Total 25.2 924 360 110 170 100 141 - 664.8 Total 1+2 69.2 1299 1555 582.5 790 256.1 153 17.5 1046.3 1.) HBV Protein 2.) LBV Protein
  29. 29. Meal Plan Food grp Ex Pro Na K Ca P Fluid CHO Fat Kcal Fruits A 2 0.8 6 240 20 20 96 20 - 83.2 B 3 0.6 6 180 15 15 126 30 - 122.4 Sugar 8.5 - - - - - - 42.5 - 170 Total 1.4 12 420 35 35 222 92.5 - 375.6 Total 1+2+3 70.6 1311 1975 617.5 825 478.1 245.5 17.5 1421.9 3.) Fruit and sugar exchange Food grp Ex Pro Na K Ca P Fluid CHO Fat Kcal Fat 3 0 120 6 3 3 3 - 15 135 A B Free foods 5 - - - - - - - 25 225 Total - 120 6 3 3 3 - 35 360 Total 1+2+3+4 70.6 1431 1981 620.5 828 481.1 245.5 57.5 1781.9 * 4.) Fat exchange *Add 148 kcal from dialysate (1781.9+148= 1929 kcal)
  30. 30. Meal PlanMeal Plan Salt Solution= 3000- 1431= 1569mg =1569/500 =3.138 or 3T Additional calcium= 1800-620.5=1179.5 mg 2 tablets

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